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Current EMDR Therapy Related ResearchProvided below is a sample of current EMDR therapy-related research. A completebibliography is available on EMDRIA’s website and our Learning Management System.Meta-Analysis “Research indicates that CBT and EMDR therapy are superior to all othertreatments” (Bisson et al., 2013). “EMDR is equivalent to exposure and other cognitive-behavioral treatments. Oneshould note that exposure therapy uses one to two hours of daily homework andEMDR uses none” (Davidson & Parker, 2001).Randomized Clinical Trials “Twelve sessions of EMDR eliminated post-traumatic stress disorder in 77.7% ofthe multiply traumatized combat veterans studied. There was 100% retention inthe EMDR condition. Clients maintained effects at follow-up. This is the onlyrandomized study to provide a full course of treatment with combat veterans”(Carlson et al., 1998). “Thirty-three 6-16-year-old children with a DSM-IV diagnosis of PTSD wererandomly assigned to eight weekly EMDR sessions or the WLC group. EMDR wasfound to be an effective treatment in children with PTSD from various sourcesand who were suffering from a variety of co-morbid conditions” (Ahmad et al.,2007).Long Term Effect of EMDR EMDR treatment resulted in lower scores (fewer clinical symptoms) on all fouroutcome measures at the three-month follow-up, compared to those in theroutine treatment condition. The EMDR group also improved on all standardizedmeasures at 18 months follow-up (Edmond & Rubin, 2004, Journal of ChildSexual Abuse) (Edmond et al., 1999). Employees who had experienced “person-under-train accident or had beenassaulted at work were recruited.” Six sessions of EMDR resulted in remission ofPTSD in 67% compared to 11% in the waitlist control. Significant effects weredocumented in the Global Assessment of Function (GAF) and HamiltonDepression (HAM-D) score (Hogberg, 2007).o Follow-up: Outcome is stable in a 35-month follow-up (Hogberg, 2008).9

Treatment Guideline Studies Department of Veterans Affairs and Department of Defense (2010) “EMDR wasone of four therapies given the highest level of evidence and recommended fortreatment of PTSD.” The Substance Abuse and Mental Health Services Administration (SAMHSA) isan agency of the US Department of Health and Human Services (HHS) (2011)“This national registry (NREPP) cites EMDR as an evidence-based practice for thetreatment of PTSD, anxiety, and depression symptoms. Their review of theevidence also indicated that EMDR leads to an improvement in mental healthfunctioning.” World Health Organization (2013) “Trauma-focused CBT and EMDR are the onlypsychotherapies recommended for children, adolescents and adults with PTSD. American Psychiatric Association (2004) “EMDR was given the same status asCBT as an effective treatment for ameliorating symptoms of both acute andchronic PTSD.”Adaptive Information Processing (AIP) Research “EMDR in the treatment of borderline personality disorder. 20 EMDR sessionsthat focused on reprocessing the memories seemingly at the foundation of thepathology, along with triggers and future templates resulted in completeremission of BPD, including symptoms of affect dysregulation ” (Brown &Shapiro, 2006). “Comparison of eye movement desensitization and reprocessing with citalopramin the treatment of obsessive-compulsive disorder. “There was a significantdifference between the mean Yale-Brown scores of the two groups aftertreatment and EMDR was more effective than citalopram in the improvement ofOCD signs” (Nazari et al., 2011). “Some effects of EMDR treatment with previously abused child molesters:Theoretical reviews and preliminary findings. “As predicted by the AdaptiveInformation Processing model, the EMDR treatment of the molesters’ childhoodvictimization resulted in a decrease in deviant arousal as measured by theplethysmograph, a decrease in sexual thoughts, and increased victim empathy.Effects maintained at one year follow up” (Ricci et al., 2006).Research on Eye Movements “EMDR-with eye movements led to a greater reduction in distress thanEMDR-without eye movements” (Schubert et al., 2011). “The effect size for the additive effect of eye movements in EMDR treatmentstudies was moderate and significant” (Lee & Cuijpers, 2013). “Eye movements reduce vividness and emotionality of distressing visual imagesabout feared future events” (Englehard et al., 2010).10

Hypothesized Mechanisms of Action and Neurobiological Aspects of EMDR TherapyGiven the infancy of neurobiology, the physiological foundations of all psychotherapiesare currently unknown, and therefore, all neurobiological models of psychotherapy arespeculative. Testing of hypotheses about EMDR’s neurological mechanisms awaits thedevelopment of advanced brain imaging techniques. Theories concerning EMDR’sneurobiological mechanisms are, at this time, purely speculative. As clinicians becomemore proficient, it is advised they seek out continuing education regarding theneurobiology of EMDR. There are several theories on the role of eye movements andbilateral stimulation, which clinicians can read more about via their learner portal or theEMDRIA website.11

Understanding EMDRThe goal of EMDR is to help clients adaptively process these dysfunctionally storedmemories or events.A dysfunctionally stored memory/event still has some of the images, thoughts,emotions, and body sensations that occurred at the time of the event.“Essentially, the childhood perspective is locked in place, and it causes theperson to perceive the present from a similar vantage point of defectiveness(e.g., I’m unlovable/not good enough), lack of safety, or lack of control. Cliniciansobserve this every day in their practices: clients “know” they shouldn’t be feelinghopeless or powerless or unlovable, but they do. They may slip into the intonationof childhood when speaking of earlier experiences. There is a split between whatthey want to do and what they can do; between the possibilities available andtheir ability to perceive and act upon them” (Shapiro, 2018).An adaptively processed event means that adequate learning has taken place and thememory exists with appropriate emotions. These memories are successful in guidingthe person in future thoughts and actions.EMDR is Desensitization AND Reprocessing. The goal of EMDR therapy is to reducesymptoms of anxiety through desensitization. It also helps the client reprocess thedysfunctionally stored memory resulting in the natural replacement of their currentnegative cognition with a positive one. Bilateral stimulation is only one component ofthe complex approach.EMDR utilizes a comprehensive approach to address specific memory components,including images, beliefs, emotions, bodily sensations, and increased insight.12

Model, Methodology, and MechanismThe Adaptive Information Processing model is the underlying explanatory model ofEMDR therapy. The AIP model guides treatment, history taking, case conceptualization,treatment planning, intervention, and predicts outcome. The methodology includes theeight-phase treatment procedure of the basic EMDR therapy protocol, plus safeguards,ethics, and validated modifications for specific clinical situations. The mechanismconsists of current hypotheses regarding how or why EMDR therapy works on theneurobiological level, plus recent research exploring mechanisms of action.ModelAdaptive Information Processing Model (AIP) The neurobiological information processing system is intrinsic, physical, andadaptive. This system is geared to integrate internal and external experiences. Memories are stored in associative memory networks and are the basis ofperception, attitude, and behavior. Experiences are translated into physically stored memories. Stored memory experiences are contributors to pathology and health.Memory Networks Trauma disrupts normal adaptive information processing, resulting inunprocessed information dysfunctionally held in memory networks. Trauma can include DSM 5 PTSD Criterion A events or the experience of neglector abuse that undermines an individual’s sense of self-worth, safety, ability toassume appropriate responsibility for self or others or limits one’s sense ofcontrol or choices. New experiences link into previously stored memories, which are the basis ofinterpretations, feelings, and behaviors. If high levels of disturbance accompany experiences, they may be stored in theimplicit/non-declarative memory system. These memory networks contain theperspectives, effects, and sensations of the disturbing event and are stored in away that does not allow them to connect with adaptive information networks. When similar experiences occur (internally or externally), they link into theunprocessed memory networks and the negative perspective, affect, orsensations arise. This expanding network reinforces the previous experiences. Adaptive (positive) information, resources, and memories are also stored inmemory networks.13

Direct processing of the unprocessed information facilitates linkage to theadaptive memory networks and transforms all aspects of the memory. Non-adaptive perceptions affect, and sensations are discarded As processing occurs, there is a posited shift from implicit/non-declarativememory to explicit/declarative memory and from episodic to semantic memorysystems (Stickgold, 2002). Memory processing causes an adaptive shift in all memory components,including the sense of time and age, symptoms, reactive behaviors, and sense ofself.Clinical ImplicationsThe AIP guides case conceptualization, treatment planning, intervention and predictstreatment outcome. Clinical complaints that are not organically based or caused by insufficientinformation are viewed as stemming from maladaptively stored and unprocessedinformation, which has been unable to link with more adaptive information. Earlier memories that are maladaptively stored increase vulnerability topathology, including anxiety, depression, PTSD, and physical symptoms of stress. These maladaptively stored memories may interfere with the healthydevelopment of an individual’s sense of self-worth, safety, ability to assumeappropriate responsibility for oneself or others or limit one’s sense of control orchoices. The information processing system and stored associative memories are theprimary focus of treatment. Procedures are geared to access and process dysfunctional memories andincorporate adaptive information. The intrinsic information processing system and the client’s own associativememory networks are the most effective and efficient means to achieve optimalclinical effects. Clinicians must access targeted memories as they are currently stored to makeappropriate associative connections throughout the relevant networks. Unimpeded processing allows the full range of associations to be madethroughout the targeted memory and the more extensive integrated networks. Interventions to assist blocked processing should mimic spontaneousprocessing. All interventions change the natural course of processing and potentially closesome associated pathways. Following any intervention, the target will be reassessed and fully processed inthe original form. Processing shifts all elements of memory to an adaptive resolution.14

Differentiating EMDR from Other Models of Therapy Cognitiveo Irrational thoughts are the basis of pathologyo Cognitions change through reframing, self-monitoring, and homeworkexercises. Behavioralo Cannot see within the “black box” (the brain)o Learned behavior changes through conditioning, exposure, modeling, etc. “Third wave” of CBTo Suffering is inevitableo Change is through acceptance, commitment, and Mindfulness exercises Psychodynamico Explores the impact of Family of Origin, Object relationso Change occurs through insight or “working through”o The goal is to make the subconscious conscious Family Therapyo Problems and solutions are interactionalo Exploration and evaluation of family dynamicso Change through education and role realignment Experientialo Facilitates client self-healingo Affect and body are centralApplicationsEMDR is effective with a variety of symptoms and diagnoses: PTSDAnxiety DisordersPhobiasPanic DisorderVictims of Crime and Violent AssaultsGriefDepressionEating DisordersChildrenChemical DependencyDissociative DisordersPerformance AnxietySomatoform Disorder including Body Dysmorphia and Chronic PainPersonality DisordersSome non-validated applications still need research.15

Three-Pronged ApproachRemember: Trauma negatively impacts the healthy development of an individual.Presenting problems are tied to memories and past events, which are maladaptivelystored.Prong 1: Past: Events that laid the groundwork for the client’s current distress. Connect current symptoms with past experiences Identify early life experiences that have laid a foundation for the client’s currentdysfunctional behaviors, response patterns, bothersome emotions, and negativebeliefs about themselves, others, and the world.o These early life experiences are potential targets for reprocessing.Prong 2: Present: Present experiences that are triggering them or causing distress What led the client to seek therapy?Prong 3: Future: Potential future experiences that may be triggering What future challenges might occur?16

Three-Pronged Approach: Prong 1Past EventsEMDR is a 3-pronged approach: past, present, and future. The 8-phases handle theprocessing of memory and reduce distress related to present triggers. The futuretemplate handles the processing of future concerns that may cause distress. A clinicianhas not completed EMDR on a targeted memory until they process past maladaptivememories, present triggers and complete a future template.MethodologyThe methodology includes the eight-phase treatment procedure of the basic EMDRtherapy protocol, plus safeguards, ethics, and validated modifications for specificclinical situations.8 Phases of EMDR Treatment:Phase 1:History TakingPhase 2:PreparationPhase 3:AssessmentPhase 4:DesensitizationPhase 5:InstallationPhase 6:Body ScanPhase 7:ClosurePhase 8:Reevaluation17

Phase 1: History Taking, Case Conceptualization, andTreatment PlanningPurpose of Phase 1 To identify appropriate client selection and readiness for EMDR.o Some clients may not be appropriate for EMDR To obtain a detailed history of the client. To identify potential treatment targets.History Taking Unique to EMDR“The clinician must assess the client’s readiness and ability to uncover and withstand theinformation in order to ascertain whether or not the client can be guided through thedisturbance that may emerge as the memory is treated.” (Shapiro, 2009)Some things to look for or work toward include:Level of rapport- client’s ability to experience and tolerate vulnerabilityAffect tolerance: ability to tolerate emotional disturbanceClient’s ability to emotionally regulateAssessing for overall stabilizationDrug and alcohol abuseLegal concernsMotivation for changeTimingMedication needsPhysical/medical concernso Epilepsyo Neurological impairmentso Eye Problems Therapy interfering behaviorso Secondary gaino Present-day stressors that may need to take precedence Maintaining dual attention Dissociative disorders or dissociationo See DES in Appendix D Window of ToleranceThe window of tolerance is used to describe the zone in which an individual canfunction most effectively. When individuals are within their window of tolerance, theycan readily receive, process, and integrate information and manage the demands of18

their life without much difficulty. When an individual experiences a high level of distress,they may leave their window of tolerance and experience hyperarousal or hypoarousal.When in a state of hyperarousal or hypoarousal, one is not able to process informationeffectively. The brain’s prefrontal cortex is offline, impacting one’s ability to reason andleading to emotional dysregulation. Each individual’s window of tolerance is different,and some clients may need help learning to widen their window so they may be able totolerate intense emotions without entering a hyperaroused or hypoaroused state. Hyperarousal is the fight or flight response and may present as high anxiety,racing thoughts, anger, feeling out of control, or overwhelmed. Hypoarousal: The freeze response and the person may present as spacy,zoned-out, numb, or frozen.Dual AttentionMaintaining dual attention is imperative for EMDR therapy. Dual attention involvessimultaneously attending to present stimuli (BLS) and past trauma. Dual attentiontriggers a physiological state that leads to information processing in the brain. Stimulithat can activate the information processing system include eye movements, tactiletaps, or auditory tones. If a client cannot maintain dual attention, EMDR will beineffective. Additionally, the inability to sustain dual attention can lead to a client gettingstuck in a high level of disturbance and worsening clinical symptoms. Dual attentionmight be conceptualized as maintaining “one foot in the past and one foot in thepresent.”Indications a client is not maintaining dual attention include: Distracted in session Unable to be present; worried about the future Difficulty transitioning out of the mildly distressing event while establishingSafe/Calm PlaceInterventions when a client is not maintaining dual attention: Pause and attempt to reorient the client to the present Ask them to identify things in the room using their five senses. Specifically focuson sight, smell and touch. Was it easy for the client to transition back to the present? Remind the client about the reality of the situation by using supportivestatements such aso “It’s over now.”o “It’s in the past.”o “You are here now with me, looking back on the experience.”19

Treatment PlanningThe therapist’s goal in treatment planning is to identify parallels between the client’spast experiences and present symptoms to isolate responses patterns.*As an EMDR trained therapist, clinicians should consistently be looking for a client’sunderlying negative cognitions about themselves, others, or the world.Assess and identify the client’s

EMDR Training Group integrates the 10 hours of gr oup consultation int o the price of EMDR Basic Training in the form of fiv e prescheduled, 2-hour gr oup consultations provided by an EMDRI A Approved Consultant (A C) or Consultant in Training (CIT) associated with EMDR Training Group. Par ticipants will r egister for these consultation